Meningitis Q&A: Aspergillus can sometimes take a month to appear

Oct. 3, 2012

Meningitis hotline

The Tennessee Department of Health and the Tennessee Poison Control Center have partnered to answer questions from the public about meningitis. The number is 1-800-222-1222. Immediately press Option 1 to be connected with a person from the poison control hotline who can answer questions about meningitis.

Anyone treated at Saint Thomas Outpatient Neurosurgery Center can call the clinic at 615-341-3425 with inquiries.

Meningitis is an inflammation of the tissues that surround the brain and spinal cord and is most commonly caused by bacterial and viral infections; there are, however, five types, according to the Centers for Disease Control and Prevention.

• Bacterial meningitis is caused by bacteria such as Streptococcus pneumoniae and can be contagious. It also can be life-threatening, but there are vaccines to prevent some kinds. In September, Middle Tennessee State University student Jacob Nunley died of the illness, as did a West Elementary School student in Mt. Juliet.

• Viral meningitis is caused by viruses such as enteroviruses and herpes simplex viruses, according to the CDC. It’s serious but rarely fatal in those with healthy immune systems. It occurs mostly in children younger than 5. Parents in Williamson County are reporting cases of viral meningitis at Oak View Elementary School.

• Fungal meningitis is usually caused by inhaling fungal spores from the environment. Anyone can get fungal meningitis, but people at higher risk include those who have AIDS, leukemia or other forms of immunodeficiency, according to the CDC. It is not contagious.

• Parasitic meningitis is caused by parasites that contaminate food, water and soil, and it is uncommon in the United States, according to the CDC. The parasite typically enters through the nose and travels to the brain, where it destroys tissue.

• Non-infectious meningitis can be caused by cancers, lupus, head injury and brain surgery, the CDC website said. It is not spread person to person.

What is Aspergillus?

Aspergillus is a fungus — it’s called a mold — and it exists in the environment. “It’s around all of us, all the time,” said Dr. William Schaffner, a Vanderbilt professor who is president of the National Foundation for Infectious Diseases. “It lives in vegetation and it particularly likes damp, moldy leaves, so it’s particularly pertinent this type of year.”

The fungus is not very adept at causing illness, Schaffner said, and our immune systems ward it off readily. However, “from time to time, fortunately rather rarely, this could cause an illness in immunocompromised people.”

Aspergillosis is a disease caused by this fungus; it may induce allergic reactions, lung infections and infections in other organs, according to the CDC.

What is Aspergillus meningitis?

On occasion, the aspergillosis can get into the bloodstream and then to the brain, causing encephalitis (brain inflammation) or meningitis (the inflammation of the membranes covering the brain).

In the cases involving the epidural steroid injections, “we have a very exceedingly unusual circumstance — even more usual than aspergillosis normally is,” Schaffner said.

Is Aspergillus meningitis contagious?

No. Fungal meningitis, including that caused by Aspergillus, is not contagious.

How is meningitis diagnosed?

Symptoms include “feeling badly, a little fever, a little headache, then stiff neck and confusion,” Schaffner said. In classic meningitis cases — those caused by virus or bacteria — these symptoms usually come on rapidly. However, Schaffner said, “Aspergillus generally grows rather slowly,” so there appears to be a “rather prolonged period from time of exposure to the onset of illness,” Schaffner said. “It can extend perhaps up to a month, and symptoms can be gradual and not very impressive,” he said.

Some of the symptoms actually can mimic certain kinds of strokes, Schaffner said. He added that because of the rarity of this disease, doctors are just learning about these symptoms.

Should I go to the doctor for Aspergillus meningitis?

Those who may be involved are patients who sought relief from back pain in one of two clinics in Tennessee between July 30 and Sept. 20, said Dr. David Reagan, chief medical officer for the Tennessee Department of Health.

If you have been contacted about potential exposure, then “anything that looks unusual or abnormal in terms of your health ought to trigger you going to your health-care provider,” Schaffner said.

If I have a headache and stiff neck, but have not been contacted about potential exposure, what should I do?

Meningitis can come in various forms, and it is not limited just to this situation, Schaffner said.

“So, clearly, if you have fever, stiff neck, headache and are feeling poorly, those are reasons to get medical attention quite separate from this issue of Aspergillus,” Schaffner said.

But, to be clear, “This outbreak has no relationship to other cases of bacterial or viral meningitis that recently occurred in Tennessee,” Reagan said.

If I have received other epidural treatments, such as those used during labor and delivery, am I at risk?

No. “Epidural” is a simplified term that frequently refers to the injection of drugs into the epidural space of the spine.

Typically, during childbirth, the administered epidural is an anesthetic. In the reported meningitis cases, the epidural injection was steroids specifically given for back pain.

“In particular, we want to make sure (to convey) that women who received epidurals during the delivery process have no reason to be concerned about this cluster of cases,” Reagan said.

If I am currently in a pain management program and have not been contacted by my health professional, what should I do?

Although Schaffner emphasized that all those at risk should have been contacted, it is “fair,” he said, “to call up, identify yourself and the day you had the procedure or received injections and say, ‘I just want to make sure I am not one of the patients exposed to this problem.’ ”

Should I pursue other pain management options until this has been cleared?

No, Schaffner said. “I think you can go ahead (and continue your current pain management treatment), because every vial of this batch that is under strong suspicion has been withdrawn.”